SPINAL CORD
INJURY AND
PERIPHERAL NERVE
INJURY
Azarias Kassahun, MD, FCS(ECSA)
Assistant Professor, Neurosurgery Unit
AAU-CHS
SPINAL CORD INJURY
Introduction
Epidemiology
Approach to patient
Imaging
Management
INTRODUCTION
Insult to SC resulting
in a change of
function (sensory,
motor or autonomic)
Temporary or
Permanent
Primary or
Secondary
INTRO…
EPIDEMIOLOGY
Etiology
MVA
Falls
Assaults: knives, bullets, stick
Sport injuries
May occur with head injuries
Most are young male
Life expectancy and quality profoundly
affected.
APPROACH TO THE PATIENT
Goals of spine trauma care
Protect
Identify
Optimize conditions for recovery
ATLS: Primary Survey
Airway with c-spine stabilization
Breathing
Circulation
Disability
Exposure*
Secondary survey
APPROACH…
Secondary survey: Hx and P/E
Suspected spinal injury: high speed, unconscious,
multiple injuries, neuro deficit, tenderness
Physical exam
Inspectionand palpation : occiput to coccyx
Neurological assessment
APPROACH…
Neurological assessment: focus on
Motor exam
Sensory exam
Reflexes : Deep and Superficial
APPROACH…
Classification
Incomplete Vs Complete (ASIA)
Location
Bony/Ligamentous lesion
Incomplete cord injury: special syndromes
Anterior cord syndrome
Central cord syndrome
Brown-Sequard syndrome
APPROACH…
Anterior cord
syndrome
Lossof motor, pain
and temperature
Preserved
proprioception and
deep touch
APPROACH…
Brown-Sequard
syndrome
Loss
of ipsilateral
motor and
proprioception
Lossof cotralteral
pain and
temprature
APPROACH…
Central cord
syndrome
Upper limb weaker
than lower limb
Variable sensory
loss
Sacral sparing
IMAGING
C-spne injury
NEXUS Criteria:5/5 is low risk
1. Absence of tenderness in the posterior
midline
2. Absence of a neurological deficit
3. Normal level of alertness (GCS score = 15)
4. No evidence of intoxication (drugs or
alcohol)
5. No distracting injury/pain
Otherwise: at least XR(AP, Lat, OMO)
IMAGING…
X-ray Guidelines
AABBCDS
Adequacy, Alignment
Bone abnormality, Base of skull
Cartilage
Disc space
Soft tissue
IMAGING…
CT is better for occult
fractures and
identifying details of
fracture
MRI is good to identify
those injuries with no
bony involvement
Flexion-extension films
for stability in patient
with no deficit.
MANAGEMENT OF SPINAL
INJURY
Primary goal
prevent secondary injury
Immobilization in the initial assessment
Log roll patients
ATLS
MANAGEMENT…
Principles
Spinal
alignment:
deformity/subluxation/dislocation > Reduction
Spinal column stability: Unstable > Stabilization
Neurological deficit: Deficit > Decompression
PERIPERAL NERVE INJURY(PNI)
Anatomy
Epineurium
Encompasses nerve and runs
between fascicles
Vascular
Perineurium
Layer that covers individual
fascicles
Tensile strength
Endoneurium
Inner most collagenous matrix that
surrounds axons within fascicles
Nourish & protect axons
PNI…
Classification
1. Seddon-1943
Neurapraxia
Axonotmesis
Neurotmesis
2. Sunderland-1951
Type 1 - 5
PNI…
PNI…
Neurapraxia
Interruption of conduction at site of injury
Axon preserved
No wallerian degeneration
Motor fibers more susceptible to injury
than sensory fibers
Complete functional recovery expected
PNI…
Axonotmesis
Axon and myelin sheath disruption … leads to
conduction block with Wallerian degeneration
Endoneurium, perineurium and epineurium intact
Axon regenerates along intact endoneural tube
complete loss of function
Recovery expected depending on site and severity
PNI…
Neurotmesis
Complete loss of continuity of nerve
Varying amounts of scar form between
severed ends, with neuroma formation at
proximal stump
Wallerian degeneration of distal stump
Spontaneous recovery negligible
Requires surgical repair
